Medicine
Forewarned or foreskinned
John Linklater
We live in a strange world in which individual freedom of choice is being ruthlessly nibbled away. The news that a vociferous pressure group is agitating to abolish the practice of docking puppies' tails on the grounds of hideous cruelty, thus prompts your medical columnist to review ritual circumcision which is an identical operation, except that the penis, supplied by the puden dal nerves, is indisputably more sensitive to pain than the tail which is supplied by the sacrococcygeal nerve plexus.
The infant to be circumcised is, by humanistic definition, merely eight days removed from the to tally disposable and completely insensible foetus. By logical ar gument, therefore, such feelings as it may have, should scarcely be worth consideration. In any event, it would not warrant the depth of compassion reserved for puppies of the same age. Pressure groups are not logical, however, and the modern mania for attacking tradition is very strong. The pos sibility certainly exists that a pressure group might form to abolish circumcision.
The short, sharp, traditional chop is usually ascribed to the direct command of God, and the result serves as a tangible expression of God's covenant with Abraham and his seed. The word ing of the seventeenth chapter of Genesis makes it clear, however, that circumcision was already well and widely known at that time, otherwise Abraham and his household must have greeted the proposal with greater astonishment, to say the very least of it, and, in any case, the operating instructions would surely have been more detailed.
Circumcision is the sort of operation that could have been discovered in a much more distant past, by primitive man, almost accidentally. Infective constriction of the infant prepuce is not un common in dusty areas such as the Mediterranean basin, and the distracted prehistoric mother of a wailing infant might easily have released the pent-up urine from a painful, balloon-like phimosis, simply by gnawing at its tip with a pair of sharp incisors. Prophylactic circumcision is still useful to prevent phimosis, paraphimosis and balanitis, but a more cogent argument is that cancer of the penis in later life is virtually unknown in the man who has been circumcised in infancy. This is because circumcision prevents the prolonged contact with smegma, the whitish sebaceous secretion that inevitably builds up beneath the prepuce, notwithstanding adequate personal hygiene. Cancer of the penis is not common but, if it does occure, the treatment is surgical and sad. Parents may thus consider that the soon forgotten moment of pain at circumcision and the sacrifice of a minute rubbery ring of tissue, is a price well worth paying on this account alone.
It is possible to avoid the pain altogether by giving a general anaesthetic but this, in itself, constitutes a quite unjustified hazard. The alternative method of local analgesia is time-consuming, if effectively carried out to include the innervation of the corona] attachment of the prepuce, as well as the skin surface, and the infant struggles and shouts anyway.
A less well known, beneficial effect of circumcision is that the continual friction of clothing against the exposed glans penis gradually desensitises it, so that the male orgasm is thereby delayed. This is a real advantage in the present climate of society in which women are more inclined to assert their independence than they are to surrender, and thus often, unwittingly, fail to trigger their own orgasm until too late.
A totally altruistic reason for infant circumcision, and one which has become significant now that promiscuity is being actively encouraged, even among schoolchildren, is that it may help to reduce the incidence of cancer of the cervix. Cancer of the cervix still kills 2,000 women each year in spite of the screening campaign, and this cancer is now known to be ten times as prevalent in the very promiscuous woman as it is in the female population generally.
Cancer of the cervix was originally associated with syphilis and was considered as a sort of natural penalty for prostitution, but the correct explanation is that any promiscuity, whether for financial gain or not, leads inevitably at least to intermittent bouts of low grade vaginal infection. The chronic irritant .effect of this in fection upon the cervical cells, es pecially if exacerbated by the irritant effect of smegma, eventually alters these cells in a way that predisposes them to later cancerous changes. There is therefore likely to be a great increase in the incidence of cervical cancer within the next twenty years, but we may be able to do something towards reducing the subsequent incidence if we encourage infant circumcision now.
In any event, the balance of medical and psychological advan tages lies in favour of routine cir cumcision, which cannot thus be castigated as pure atavistic bar barism. Our puppies may be denied the pleasure of wagging a proud, upstanding, appendage but let us at least be sure that the same misplaced sentimentalism does not deprive our sons of the right to an organ that is less prone to disease and often more satisfactory in use.
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